Sabine Pircher
Louisville,United States
Summary
Dedicated compliance professional with extensive expertise in PBM regulatory frameworks, including ACA, HIPAA, URAC standards, and state-specific transparency laws. Guided by a commitment to empathy, collaboration, and openness, I excel in aligning compliance strategies with value-based care models to achieve patient-centered outcomes and organizational goals. A proven leader in developing policies and processes that mitigate risk, enhance efficiency, and ensure 340B, Medicaid, and utilization review compliance, I bring a customer-focused approach to compliance, prioritizing transparency and innovation. Passionate about fostering meaningful results, I strive to build trust and deliver impactful solutions that benefit patients, health plans, and stakeholders while embracing diversity and adaptability.
Overview
17
17
years of professional experience
1
1
Certificate
Work History
Arbitration Specialist and Quality Assurance Subject Matter Expert
Provider Resources Inc.
Erie, United States
04.2023 - 10.2024
- Directed the establishment and execution of compliance monitoring and auditing systems (e.g., compliance assurance program) to meet regulatory obligations under the federal arbitration framework
- Supervised departmental workflow procedures to ensure compliance with federal arbitration program requirements and to keep the organization informed of updates to state and federal regulations
- Conducted investigations into potential violations of laws, policies, and the Company’s Code of Conduct, ensuring adherence to conflict-of-interest policies and federal arbitration standards
- Led audit functions in collaboration with key stakeholders, guaranteeing compliance with arbitration program rules and regulatory expectations
- Coordinated and supported the development, tracking, and implementation of corrective action plans to address compliance gaps effectively
- Participated actively in Enterprise leadership committees, including Quality Management and Compliance, providing insights relevant to federal arbitration requirements and organizational goals
Senior Regulatory Compliance Administrator
CareCentrix Inc.
Tampa, United States
07.2021 - 10.2022
- Directed the URAC accreditation processes, ensuring adherence to ongoing requirements and facilitating annual re-accreditation to uphold organizational standards
- Spearheaded the creation and implementation of policies and procedures to align with licensing and accreditation requirements, ensuring compliance with federal and state regulations, including privacy mandates
- Supervised the acquisition and renewal of essential licenses (TPA and UR) and certifications, guaranteeing timely submissions to relevant state and federal authorities
- Monitored and maintained detailed licensing records, ensuring all filings with state regulators were accurate and submitted within required deadlines to maintain compliance
Senior Regulatory Compliance Professional
Humana Inc.
Louisville, United States
03.2012 - 07.2021
- Accountable for tracking, monitoring, interpreting, and communicating federal and state regulations related to Humana’s PBM program, ensuring the organization remains compliant with all enacted rules
- Developed and maintained comprehensive knowledge of issues related to broad spectrum PBM offerings (e.g., Rebate Transparency and AKS Violations, Drug Pricing Transparency, Network Adequacy & Patient Access, HIPAA and Privacy, UM Disputes, Specialty Drug Management, 340B Compliance)
- Reviewed compliance strategies for new state entries and product launches, ensuring alignment with regulatory requirements and timely submission approvals
- Directed the policy and procedure process, updating and maintaining documents to adhere to PBM-related rules and regulations
- Led and conducted investigations into compliance and privacy concerns, ensuring accuracy and prompt notification of affected parties while addressing PBM-specific issues
- Delivered timely and effective annual training sessions on policies and procedures, equipping employees with the tools to meet compliance obligations
Regulatory Risk Advisor
Humana Inc.
Louisville, United States
02.2008 - 03.2012
- Tracked and interpreted regulatory changes to proactively update policy language and ensure alignment with evolving requirements
- Managed and responded to regulatory inquiries, mitigating risks and fostering strong relationships with state agencies
- Delivered regulatory research projects, producing comprehensive internal reports and developing processes and procedures to support compliance initiatives
- Supervised workflow processes to ensure alignment with regulatory compliance requirements, maintaining the company’s adherence to current state and federal regulations
- Partnered with clinical teams, data analysts, client representatives, and other stakeholders to identify and implement enhancements for compliance with existing and emerging federal and state standards
- Delivered real-time compliance advice and support to business units and subsidiaries, addressing multiple regulatory concerns promptly
Education
Master of Arts - Political Science
University of Louisville
Louisville, KYBachelor of Arts - Political Science
University of Louisville
Louisville, KYSkills
- Federal and state regulations
- Data privacy
- Risk management strategies
- Regulatory compliance
- Pricing strategy
- Teamwork and collaboration
Certification
- Certified in Healthcare Compliance (CHC), 07/01/25, +10 CEUs
- Certified Six Sigma Green Belt, Humana Inc.
Timeline
Arbitration Specialist and Quality Assurance Subject Matter Expert
Provider Resources Inc.
04.2023 - 10.2024
Senior Regulatory Compliance Administrator
CareCentrix Inc.
07.2021 - 10.2022
Senior Regulatory Compliance Professional
Humana Inc.
03.2012 - 07.2021
Regulatory Risk Advisor
Humana Inc.
02.2008 - 03.2012
Master of Arts - Political Science
University of Louisville
Bachelor of Arts - Political Science
University of Louisville
Other
Duke University – Regulatory Affairs Training Program, non-certificate
- Drug Development and FDA Meetings
- Applicability of FDA Drug Regulations to Clinical Studies
- IND Content, Format, Review and Maintenance
Coursera - Introduction to Generative AI in Healthcare (certificate in progress)
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